Expedition Volunteer Program Application

Positions are filled up to three months prior to travel. All unsuccessful applications will be added to our standby database in case of last minute cancellations.

    First Name:

    Last Name:

    Gender:

    Telephone:

    Street:

    City:

    State:

    Date of Birth:

    Email:

    Available dates for volunteering:

    Nationality/Country of Birth:

    Select One:

    Previously Dived w/ MBDE:

    Position:

    Dive Certification:

    Date issued:

    Total Dives:

    Ocean Dives:

    Deeper than 30 metres:

    Dive Deck – Employment Details

    Company last worked at (Dive Deck):

    Date employed from:

    Date employed to:

    Manager’s name:

    Manager’s number:

    Manager’s email:

    Domestic – Employment Details

    Company name (Domestic):

    Date employed from:

    Date employed to:

    Manager’s name:

    Manager’s number:

    Manager’s email:

    Next of Kin Name:

    Next of Kin Telephone:

    In 100 words or less describe your role and responsibilities with the above employer:

    Medical History

    Please answer the following questions on your past or present medical history with a YES or NO. If you are not sure, answer YES.

    Do you regularly take prescription or non-prescription medication?:

    History of diving accidents or decompression sickness?:

    Asthma?:

    A high cholesterol level?:

    Frequent or severe attacks of hayfever or allergy?:

    Frequent colds, sinusitis or bronchitis?:

    Any form of lung disease?:

    Pneumothorax (collapsed lung)?:

    History of chest surgery?:

    Epilepsy, seizures, convulsions or take medications to prevent them?:

    Recurring migraine headaches or take medications to prevent them?:

    History of blackouts or fainting (full/partial loss of consciousness)?:

    Do you frequently suffer form motion sickness (seasick, carsick, etc)?:

    History of recurrent back problems?:

    History of diabetes?:

    History of back, arm or leg problems following surgery, injury or fracture?:

    Inability to perform moderate exercise (eg: walk one mile within 12 minutes):

    History of high blood pressure or take medicine to control blood pressure?:

    History of any heart disease?:

    History of ear disease, hearing loss or problems with balance?:

    History of bleeding or other blood disorders?:

    History of any type of hernia?:

    History of ulcers or ulcer surgery?:

    History of drug or alcohol abuse?:

    History of skin disorders, dermatitis, melanomas, skin cancer, etc?:

     

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    Mike Ball Dive Expeditions